| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
20,428 |
19,486 |
$1.08M |
| D0274 |
Bitewings - four radiographic images |
24,642 |
23,518 |
$897K |
| D0120 |
Periodic oral evaluation - established patient |
27,463 |
26,352 |
$665K |
| D1120 |
Prophylaxis - child |
13,008 |
12,603 |
$636K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,225 |
4,124 |
$592K |
| D0220 |
Intraoral - periapical first radiographic image |
32,511 |
30,690 |
$521K |
| D1351 |
Sealant - per tooth |
12,747 |
3,586 |
$487K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,120 |
16,525 |
$479K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,829 |
25,227 |
$398K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,365 |
3,026 |
$347K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,404 |
7,098 |
$321K |
| D0140 |
Limited oral evaluation - problem focused |
8,105 |
7,653 |
$305K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,313 |
1,724 |
$250K |
| D0210 |
Intraoral - complete series of radiographic images |
3,387 |
3,286 |
$227K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,166 |
729 |
$158K |
| D2740 |
Crown - porcelain/ceramic |
77 |
66 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
544 |
389 |
$50K |
| D2335 |
|
266 |
146 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,158 |
1,113 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,049 |
1,026 |
$28K |
| D2950 |
|
131 |
116 |
$21K |
| D2332 |
|
113 |
63 |
$12K |
| D2330 |
|
152 |
89 |
$11K |
| D2331 |
|
110 |
81 |
$9K |
| D4342 |
|
62 |
30 |
$5K |
| D4341 |
|
31 |
12 |
$4K |
| D7111 |
|
24 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$2K |
| D0273 |
|
26 |
26 |
$798.00 |
| D0270 |
|
36 |
33 |
$426.00 |
| D1999 |
|
17,796 |
15,068 |
$0.00 |